Rapid assay for detection of SARS-CoV-2 antibodies

ABSTRACT

Described herein are diagnostic and control fusion protein reagents and methods for use thereof in simple rapid and inexpensive hemagglutinin assays for the detection of subject antibodies directed to the SARS-CoV-2 virus.

REFERENCE TO SEQUENCE LISTING

This application is filed with a Computer Readable Form of a Sequence Listing in accordance with 37 C.F.R. § 1.821(c). The text file submitted by EFS, “026389-9305-US01_sequence_listing_3 Aug. 2021_ST25.K” was created on Aug. 3, 2021, contains 67 sequences, has a file size of 199 Kbytes, and is hereby incorporated by reference in its entirety.

TECHNICAL FIELD

Described herein are diagnostic and control fusion protein reagents and methods for use thereof in simple rapid and inexpensive hemagglutinin assays for the detection of subject antibodies directed to the SARS-CoV-2 virus.

BACKGROUND

The COVID19 pandemic caused by SARS-CoV-2 approaches its first anniversary with close to one million deaths worldwide. At this point, countermeasures are largely restricted to symptomatic therapeutic interventions and prophylactic social distancing. Without a clear timeline for the availability of better therapeutic options and just starting vaccination efforts, it is clear that proper pandemic management hinges on the availability of diagnostic tests, including those revealing the presence of the virus itself to identify infectious carriers as well as those detecting antibody responses to assess the kinetics of the pandemic and the susceptibility of individual patients and the population at large. The latter aspect will also be relevant for evaluation and guidance of large-scale vaccination efforts.

Proper management of the pandemic caused by SARS-CoV-2 (COVID19) depends on laboratory tests that reliably detect (i) active virus, to identify virus carriers and (ii) SARS-CoV-2-specific antibodies, to identify individuals who were previously exposed to SARS-CoV-2, are at risk for infection or have successfully been vaccinated.

As investigated in detail in a comparative meta-analysis study, a significant (and growing) number of antibody tests are currently availabel, including various ELISAs (enzyme-linked immunosorbent assay) and related technologies, such as ECLIA (electrochemiluminescence immunoassay), FMIA (fluorescent microsphere Immunoassay), CMIA (chemiluminescent microparticle immunoassay) and ELFA (enzyme-linked fluorescence assay) [1]. Most of these tests exhibit appropriate specificity and sensitivity and are suitable for high throughput format in diagnostic laboratories [1]. Disadvantages include their restriction to special equipment and professional laboratories, relatively high costs and long turn-around times from sample acquisition to results. An alternative technology is the lateral flow immuno-assay (LVIA), which in principle can be conducted with minimal laboratory equipment. However, as also analyzed directly in referenced study, LFIAs typically exhibit appropriate specificity but restricted sensitivity, usually below 80%, and are relatively expensive (˜$18 per test) [1].

While small, short-term studies indicated that antibody responses in asymptomatic patients may wean after weeks, at least two large scale studies have now demonstrated that antibody levels in symptomatic patients against the Spike protein and the Nucleocapsid (N) protein (NP) remain sustained at relatively high levels for at least 4-6 months [2]. These studies suggest that assessment of SARS-CoV-2-specific antibodies represents a proper tool for epidemiological studies and, likely, at least intermediate-term protection of convalescent patients. While studies so far are based on tests using the Spike or Nucleocapsid proteins as antigens, a recent study using luciferase-immunoprecipitation highlighted additional immunogenic proteins of SARS-CoV-2, in particular a small protein encoded by the open reading frame (ORF) 8 (ORF8), a known pathogenicity factor [3].

What is needed are simple, rapid, and inexpensive field tests for the detection of SARS-CoV-2-specific antibodies.

SUMMARY

One embodiment described herein is a nucleotide sequence encoding a polypeptide, wherein the polypeptide comprises a human red blood cell binding antibody domain (RBD) and a SARS CoV-2 virus protein domain (CVD). In one aspect, the RBD comprises a glycophorin A-binding nanobody comprising 90-99% identity to SEQ ID NO: 22. In another aspect, the CVD comprises one or more of a spike protein, a nucleocapsid protein, ORF8 protein, ORF3b protein, or envelope protein comprising 90-99% identity to all or a portion of SEQ ID NO: 24, 26, 28, or 30. In another aspect, the polypeptide has the structure: SS-GAP-RBD-GL2-CVD-GL3-AFT or SS-GL1-RBD-GL2-CVD-GL3-CVD-GL4-AFT; wherein: SS is a secretion signal domain; RBD is a glycophorin A-binding nanobody domain; GAP, GL1, GL2, GL3, and GL4 are linker domains; CVD is a SARS CoV-2 virus polypeptide domain comprising a spike protein, nucleocapsid protein, ORF8 protein, ORF3b protein, or envelope protein domains; and AFT is an affinity purification tag sequence. In another aspect, the SS comprises 90-99% identity to SEQ ID NO: 20. In another aspect, the GAP, GL1, GL2, GL3, or GL4 comprises 90-99% identity to one or more of SEQ ID NO: 38, 40, 42, 44, or 46. In another aspect, the AFT comprises 90-99% identity to one or more of SEQ ID NO: 58, 60, 62, or 64. In another aspect, the nucleotide sequence has 90% to 99% identity to SEQ ID NO: 1, 3, 5, 7, 9, or 11. In another aspect, the nucleotide sequence is one of SEQ ID NO: 1, 3, 5, 7, 9, or 11.

Another embodiment described herein is a polynucleotide vector comprising a nucleotide sequence described herein.

Another embodiment described herein is a cell comprising a polynucleotide vector comprising a nucleotide sequence described herein.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein, wherein the polypeptide has 90% to 99% identity to SEQ ID NO: 2, 4, 6, 8, 10, or 12.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein, wherein the polypeptide is SEQ ID NO: 2, 4, 6, 8, 10, or 12.

Another embodiment described herein is a diagnostic reagent or research tool comprising a polypeptide encoded by the nucleotide sequence described herein.

Another embodiment described herein is a method or means for manufacturing a nucleotide sequence as described herein or a polypeptide encoded by the nucleotide sequence, the process comprising: transforming or transfecting a cell with a nucleic acid comprising the nucleotide sequence; growing the cells; optionally, harvesting the cells and isolating quantities of the nucleotide sequence; inducing expression of a polypeptide encoded by the nucleotide sequence; harvesting the cells; and isolating and purifying the polypeptide.

Another embodiment described herein is a nucleotide sequence or a polypeptide encoded by the nucleotide sequence, each produced by a method or means described herein.

Another embodiment described herein is a nucleotide sequence encoding a diagnostic control polypeptide, wherein the polypeptide comprises: (a) a glycophorin A-binding nanobody domain comprising 90-99% identity to SEQ ID NO: 22; (b) one or more anti-SARS Co-V-2 nanobody domains comprising 90-99% identity to SEQ ID NO: 32 and one or more multimerization domains comprising 90-99% identity to SEQ ID NO: 34 o4 36. In one aspect, the polypeptides have the structure: SS-GAP-RBD-G L5-AFT; SS-GAP-anti-CVD-GL6-anti-CVD-GL7-IgGFC-GL8-AFT; or SS-GAP-anti-CVD-GL6-anti-CVD-SGT-HIZD-GL8-AFT; wherein: SS is a secretion signal domain; RBD is a glycophorin A-binding nanobody domain; GAP, GL5, GL6, GL7, GL8, and SGT are linker domains; Anti-CVD is an anti-SARS CoV-2 surface glycoprotein receptor binding domain nanobody domain; IgGFC is a human immunoglobulin FC dimerization domain; HIZD is a Hinge-isoleucine zipper trimerization domain; and AFT is an affinity purification tag sequence. In another aspect, the SS comprises 90-99% identity to SEQ ID NO: 20. In another aspect, the GAP, SGT, GL5, GL6, GL7, or GL8 comprises 90-99% identity to one or more of SEQ ID NO: 38, 48, 50, 52, 54, or 56. In another aspect, the AFT comprises 90-99% identity to one or more of SEQ ID NO: 58, 60, 62, or 64. In another aspect, the nucleotide sequence has 90% to 99% identity to SEQ ID NO: 13, 15, or 17. In another aspect, the nucleotide sequence is one of SEQ ID NO: 13, 15, or 17.

Another embodiment described herein is a polynucleotide vector comprising a nucleotide sequence encoding a diagnostic control polypeptide as described herein.

Another embodiment described herein is a cell comprising a polynucleotide vector comprising a nucleotide sequence encoding a diagnostic control polypeptide as described herein.

Another embodiment described herein is a diagnostic control polypeptide as described herein.

Another embodiment described herein is a diagnostic control polypeptide having 90% to 99% identity to SEQ ID NO: 14, 16, or 18.

Another embodiment described herein is a diagnostic control polypeptide having the polypeptide sequence of SEQ ID NO: 14, 16, or 18.

Another embodiment described herein is a diagnostic reagent or research tool comprising a polypeptide encoded by a nucleotide sequence described herein.

Another embodiment described herein is a diagnostic or control polypeptide comprising the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

Another embodiment described herein is a method for evaluating whether a subject is infected or has been infected with SARS-CoV-2, the method comprising: (a) providing a sample of a biological fluid from a subject in need of diagnosis; (b) combining the biological fluid with a diagnostic polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12 to form a subject sample; (c) optionally, combining a negative control reagent or a positive control polypeptide comprising 90 to 95% identity to the amino acid sequence of SEQ ID NO: 14 (negative control) or SEQ ID NO: 16 or 18 (positive controls), with the biological fluid and a diagnostic polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 10, or 12 to form one or more control samples; (d) permitting the subject sample and control samples to incubate for a period of time; (e) evaluating the results by visualization, imaging, optical density, impedance, or microscopy; and (f) optionally, comparing the subject sample and control samples to validate the subject sample results; wherein the presence of hemagglutination in the subject sample is a positive diagnostic indication of SARS-CoV-2 infection, and the absence of hemagglutination in the subject sample is a negative diagnostic indication of SARS-CoV-2 infection. In one aspect, the biological fluid is whole blood, plasma, or serum. In another aspect, when the biological fluid is plasma or serum, washed human red blood cells of blood group O are combined with the subject sample and the diagnostic or control polypeptides in steps (b) or (c). In another aspect, wherein the diagnostic or control polypeptides have a concentration of about 10 μg/mL to about 100 μg/mL. In another aspect, the subject sample and/or control samples in steps (b) and/or (c) are dispensed on a test card, glass slide, microtiter plate, or other substrate prior to step (d). In another aspect, when the subject sample has a positive diagnostic indication of SARS-CoV-2 infection, the method further comprises: (g) administering one or more therapeutics or treatments to the subject.

Another embodiment described herein is a kit comprising: (a) one or more diagnostic or control polypeptides comprising the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18; (b) a test substrate; and (c) optionally, a label or instructions for use. In one aspect, the kit further comprises one or more of alcohol saturated towelettes; finger prick lances, capillaries, or gloves.

Another embodiment described herein is the use of a polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 for the diagnosis of SARS-CoV-2 in a subject in need of diagnosis thereof.

DESCRIPTION OF THE DRAWINGS

FIG. 1 shows schematic representations of the diagnostic and control fusion protein constructs. Key: S, secretion signal (IFNβ); IH4vs2, GPA-specific nanobody IH4vs2, which is efficiently secreted from mammalian cells (as opposed to the original IH4 nanobody); L, flexible linker; Spike, Spike-RBD of SARS-CoV-2; S-tag, Tandem-Strep-tag mediating binding to StrepTactin® matrix (IBA) for affinity purification; Nucleocapsid, Nucleocapsid protein of SARS-CoV-2, ORF8, ORF8 of SARS-CoV-2, ORF3b, ORF3b of SARS-CoV-2; 2xαSpike-Nano, tandem-fusion construct of two Spike-RBD-binding H11-D4 nanobodies, separated by flexible linker; Hinge-IgG1-FC, dimerizing Hinge-FC moiety of IgG1; Hinge-ILZ, trimerizing hinge-isoleucin-zipper domain. Polypeptide sequences are shown in Table 1.

FIG. 2 shows the principle of Nano-spike-mediated hemagglutination in the presence of virus-specific (e.g., Spike-specific) antibodies (or the positive control nanobody, such as NanoLink).

FIG. 3 shows a fusion protein of the IH4 nanobody and the Spike RBD is not efficiently secreted. A fusion construct of the IH4 nanobody (SEQ ID NO: 65-66) and the Spike-RBD (IH4-Spike) was transfected into HEK293T cells along with a negative (vector) control and a positive control construct, and protein expression was analyzed in the cell pellet and the supernatant. Note the almost complete lack or IH4-Spike in the supernatant. Vector only-transfected cells (vector only) and cells transfected with a secreted control protein (positive control) show expected results.

FIG. 4 shows two mutations in the IH4 nanobody permit efficient secretion of Spike-RBD fusion proteins. Fusion constructs with modified forms of IH4 (IH4vs2) (SEQ ID NO:21-22), i.e., IH4vs2-Spike (i.e., “NanoSpike”; SEQ ID NO:1-2) and a similar construct containing an Igk-leader sequence (instead of the lfnb leader sequence of NanoSpike) were purified from the supernatant of transfected Expi293F™ (Thermo Fisher Scientific) cells, followed by SDS PAGE and protein (Sypro Ruby) stain. Protein yield from 25 mL of Expi293F™ cell cultures were 2.3 mg (NanoSpike) and 2.9 mg (NanoSpike-Igk). BSA at 10 μg, 2 μg, and 0.4 μg is shown for comparison.

FIG. 5 shows an example of recombinant protein production. Indicated proteins were expressed in Expi293F™ (Thermo Fisher Scientific) cells and purified by affinity purification followed by SDS PAGE and protein (Sypro Ruby) stain. Protein yield from 25 mL of Expi293F™ cell cultures were 2 mg (NanoControl; SEQ ID NO: 14), 3.75 mg (NanoSpike; SEQ ID NO: 2), 0.55 mg (NanoNuc; SEQ ID NO: 4) and 1.25 mg (NanoLink; SEQ ID NO: 16). BSA at 10 μg, 2 μg, and 0.4 μg is shown for comparison.

FIG. 6 shows that recombinant proteins containing the Glycophorin A-binding nanobody IH4vs2 bind human red blood cells. Flow cytometry analysis of human RBC that were treated with 30 μg/mL recombinant proteins (as indicated), followed by incubation without (dark) or with FITC-labeled antibody against the Strep-tag (light).

FIG. 7 shows that nanobody-fusion proteins bind RBCs rapidly and quantitatively. Kinetics of RBC-binding of nanobody-fusion proteins analyzed by flow cytometry. Anti-Strep-FITC antibody alone (control) or together with indicated recombinant proteins was added to human RBC (time point 0) and binding was analyzed by flow cytometry during time.

FIG. 8 shows that serum from a COVID19 convalescent patient triggers Nanospike- and NanoNuc-mediated hemagglutination. Indicated recombinant proteins (30 μg/mL) were added to washed RBC along with serum from a COVID19 convalescent patient (left) or a healthy control patient (right). The mixture was spread with a pipette tip and analyzed after a short incubation.

DETAILED DESCRIPTION

Unless otherwise defined, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art. For example, any nomenclatures used in connection with, and techniques of, cell and tissue culture, molecular biology, immunology, microbiology, genetics, and protein and nucleic acid chemistry and hybridization described herein are well known and commonly used in the art. In case of conflict, the present document, including definitions, will control. Preferred methods and materials are described below, although methods and materials similar or equivalent to those described herein can be used in practice or testing of the present invention.

As used herein, the terms “amino acid,” “nucleotide,” “polynucleotide,” “vector,” “polypeptide,” and “protein” have their common meanings as would be understood by a biochemist of ordinary skill in the art. Standard single letter nucleotides (A, C, G, T, U) and standard single letter amino acids (A, C, D, E, F, G, H, I, K, L, M, N, P, Q, R, S, T, V, W, or Y) are used herein.

As used herein, the terms such as “include,” “including,” “contain,” “containing,” “having,” and the like mean “comprising.” The present disclosure also contemplates other embodiments “comprising,” “consisting of,” and “consisting essentially of,” the embodiments or elements presented herein, whether explicitly set forth or not.

As used herein, the term “a,” “an,” “the” and similar terms used in the context of the disclosure (especially in the context of the claims) are to be construed to cover both the singular and plural unless otherwise indicated herein or clearly contradicted by the context. In addition, “a,” “an,” or “the” means “one or more” unless otherwise specified.

As used herein, the term “or” can be conjunctive or disjunctive.

As used herein, the term “substantially” means to a great or significant extent, but not completely.

As used herein, the term “about” or “approximately” as applied to one or more values of interest, refers to a value that is similar to a stated reference value, or within an acceptable error range for the particular value as determined by one of ordinary skill in the art, which will depend in part on how the value is measured or determined, such as the limitations of the measurement system. In one aspect, the term “about” refers to any values, including both integers and fractional components that are within a variation of up to ±10% of the value modified by the term “about.” Alternatively, “about” can mean within 3 or more standard deviations, per the practice in the art. Alternatively, such as with respect to biological systems or processes, the term “about” can mean within an order of magnitude, in some embodiments within 5-fold, and in some embodiments within 2-fold, of a value. As used herein, the symbol “˜” means “about” or “approximately.”

All ranges disclosed herein include both end points as discrete values as well as all integers and fractions specified within the range. For example, a range of 0.1-2.0 includes 0.1, 0.2, 0.3, 0.4 . . . 2.0. If the end points are modified by the term “about,” the range specified is expanded by a variation of up to ±10% of any value within the range or within 3 or more standard deviations, including the end points.

As used herein, the terms “control,” or “reference” are used herein interchangeably. A “reference” or “control” level may be a predetermined value or range, which is employed as a baseline or benchmark against which to assess a measured result. “Control” also refers to control experiments or control cells.

As used herein, the term “subject” refers to an animal. Typically, the subject is a mammal. A subject also refers to primates (e.g., humans, male or female; infant, adolescent, or adult), non-human primates, rats, mice, rabbits, pigs, cows, sheep, goats, horses, dogs, cats, fish, birds, and the like. In one embodiment, the subject is a human. In another embodiment, the subject is a human suspected of being infected with SARS-CoV-2 or that is infected with SARS-CoV-2.

As used herein, a subject is “in need of treatment” if such subject would benefit biologically, medically, or in quality of life from such treatment. A subject in need of treatment does not necessarily present symptoms, particular in the case of preventative or prophylaxis treatments. In one aspect, the subject may need diagnosis of a condition prior to treatment. Embodiments described herein can be used to make or confirm such a diagnosis.

As used herein a subject is “in need of diagnosis” if such subject would benefit biologically, medically, or in quality of life from such diagnosis. In one embodiment a subject needs diagnosis of SARS-CoV-2. In one aspect the subject may be presenting symptoms of SARS-CoV-2, may have been exposed to another individual presenting symptoms of SARS-CoV-2, may be a “carrier” of SARS-CoV-2 (without clinical presentation or symptoms), or may have previously been infected with SARS-CoV-2 and is in need of confirmation of such infection.

As used herein, the terms “inhibit,” “inhibition,” or “inhibiting” refer to the reduction or suppression of a given biological process, condition, symptom, disorder, or disease, or a significant decrease in the baseline activity of a biological activity or process.

As used herein, “treatment” or “treating” refers to prophylaxis of, preventing, suppressing, repressing, reversing, alleviating, ameliorating, or inhibiting the progress of biological process including a disorder or disease, or completely eliminating a disease. A treatment may be either performed in an acute or chronic way. The term “treatment” also refers to reducing the severity of a disease or symptoms associated with such disease prior to affliction with the disease. “Repressing” or “ameliorating” a disease, disorder, or the symptoms thereof involves administering a cell, composition, or compound described herein to a subject after clinical appearance of such disease, disorder, or its symptoms. “Prophylaxis of” or “preventing” a disease, disorder, or the symptoms thereof involves administering a cell, composition, or compound described herein to a subject prior to onset of the disease, disorder, or the symptoms thereof. “Suppressing” a disease or disorder involves administering a cell, composition, or compound described herein to a subject after induction of the disease or disorder thereof but before its clinical appearance or symptoms thereof have manifest. In one embodiment, after diagnosis of a subject being infected with SARS-CoV-2, a variety of treatments may be administered to target the virus, ameliorate symptoms, or provide palliative care.

Coronaviruses (CoVs), are enveloped positive-sense RNA viruses, which are surrounded by crown-shaped, club-like spikes projection on the outer surface. Coronaviruses' spike proteins are glycoproteins that are embedded over the viral envelope. This spike protein attaches to specific cellular receptors and initiates structural changes of spike protein, and causes penetration of cell membranes, which results in the release of the viral nucleocapsid into the cell. These spike proteins determine host trophism. Coronaviruses have a large RNA genome, ranging in size from 26 to 32 kilobases and capable of obtaining distinct ways of replication. Like other RNA viruses, coronaviruses under-go replication of the genome and transcription of mRNAs upon infection. Coronavirus infection in a subject can result in significant and long-term damage of the lungs, leading to possibly sever respiratory issues.

As used herein “SARS-CoV-2” is a beta-coronavirus (Beta-CoV or β-CoV). In particular, SARS-CoV-2 is a Beta-CoV of lineage B. SARS-CoV-2 may also be known as “2019-nCoV” or 2019 novel coronavirus. The disease associated with SARS-CoV-2 is known as COVID-19. Beta-coronaviruses are one of four genera of coronaviruses and are enveloped, positive-sense, single-stranded RNA viruses of zoonotic origin. Beta-coronaviruses mainly infect bats, but they also infect other species like humans, camels, and rabbits. SARS-CoV-2 may be transferable between animals, such as between humans. As used herein “viral transmission” is the process by which viruses spread between host subjects. Transmission occurs from person to person by direct or indirect contact or exposure. Examples of direct contact include, but are not limited to, the exchange of body fluids between a subject infected with the virus and someone else. Indirect contact includes, but is not limited to, exposure to bodily fluid droplets produced by a subject infected by the virus during coughing and/or sneezing. Beta-CoVs may induce fever and respiratory symptoms in humans. The SARS-CoV-2 receptor binding domain (RBD) of the spike protein binds to the human angiotensin-converting enzyme 2 (ACE2) receptor as a means for entering cells.

Diagnosis of SARS-CoV-2 may comprise a positive test for SARS-CoV-2 virus, viral RNA, subject antibodies against SARS-CoV-2 antigens, and/or onset of SARS-CoV-2 symptoms, or combinations thereof. The reagents and method described herein permit the diagnosis of infection of SARS-CoV-2 by reacting with antibodies produced by the subject in response to the SARS-CoV-2 infection. Symptoms of SARS-CoV-2 infection (COVID-19) include, but are not limited to, one or more of the following symptoms: nasal congestion, sore throat, fever, body aches, exhaustion, dry cough, difficulty breathing, or a combination thereof. Subjects at higher risk of developing complications may be immunocompromised (e.g., undergoing cancer treatment, bone marrow or organ transplantation, immune deficiencies, poorly controlled HIV or AIDS, prolonged use of corticosteroids or immune weakening medications), have an underlying medical condition (e.g., diabetes, renal failure, liver disease), are pregnant, are at least 65 years of age, have a chronic lung disease, have a heart disease, or combinations thereof.

Given the urgent need for evaluation of SARS-CoV-2-specific antibodies in a population for individual patients and the currently availabel tests with noted limitations, there is a significant need for rapid, simple, and affordable antibody tests with appropriate specificity and sensitivity. Such tests will allow decentralized testing of patients for SARS-CoV-2-specific antibodies, thus facilitating epidemiological management and vaccination efforts required to manage this pandemic effectively. Described herein is an assay based on (a) recombinant protein(s) that trigger(s) visible hemagglutination instantly in the presence of SARS-CoV-2 antibodies. The data provided herein establish proof of principle for this method.

The methods described herein are based on one or more recombinant fusion proteins containing at least three domains, i.e., a small camelid-derived antibody (nanobody) that binds to Glycophorin A (GYPA) on the surface of red blood cells (RBC) with high affinity, a SARS-CoV-2-specific immunogenic protein, such as the surface glycoprotein receptor “Spike” protein that serves as antigen for Coronavirus-directed antibodies, and an epitope-tag that is used for protein purification. The polypeptides also have an INF-13 secretion sequence at the N-terminus to permit secretion from the expression cells. One embodiment described herein is the “NanoSpike,” (SEQ ID NO: 2) which refers to the respective nanobody and SARS-CoV-2 surface glycoprotein receptor “Spike” domains of the fusion protein (FIG. 1; Table 1). As described herein NanoSpike can efficiently be expressed in various mammalian cell lines and binds to the glycophorin protein on the surface of human red blood cells. Importantly, when added to whole blood containing SARS-CoV-2-specific antibodies of subjects infected with or convalescing from SARS-CoV-2, NanoSpike triggers instant hemagglutination that is easily detected by visual observation or other means such as optical density, impedance, microscopy, imaging, or applications developed for this purpose. Other embodiments useful in the assay include “NanoNuc” (SEQ ID NO: 4), “NanoORF8” (SEQ ID NO: 6), “NanoSpikeORF8” (SEQ ID NO: 8), “NanoORF3b” (SEQ ID NO: 10), and “NanoSpikeORF3b” (SEQ ID NO: 12), which refer to the nanobody and SARS-CoV-2 nucleocapsid, ORF 8, surface glycoprotein receptor binding domain and ORF 8, ORF 3b, and ORF 3b and surface glycoprotein receptor binding domains, respectively. Each of these fusion proteins permits the detection of subject antibodies against these various SARS-CoV-2 antigens. Polypeptide sequences of these constructs are shown in Table 1. The complete SARS-CoV-2 genome is disclosed in SEQ ID NO: 65 (GenBank: MT072688.1). Other SARS-CoV-2 viral polypeptides are potentially useful for alternative embodiments of the diagnostic or control polypeptides described herein.

Also described herein are fusion proteins that can serve as negative or positive controls for the method or assay described herein. In one embodiment, the fusion protein “NanoControl” (SEQ ID NO: 14) can be used as a negative control. NanoControl comprises the Glycophorin A nanobody domain, but no COVID domain. This polypeptide will not react with SARS-CoV-2-specific antibodies of subjects infected with or convalescing from SARS-CoV-2 when added to a sample of the subject's blood. This construct serves as a negative control.

Alternatively, the “NanoLink” (SEQ ID NO: 16) and “NanoTrim” (SEQ ID NO: 18) fusion proteins can be used as positive controls for the method or assay described herein. NanoLink and NanoTrim fusion proteins both contain two repeated SARS-CoV-2-specific nanobody (H11-D4) domains that recognize the receptor binding domain of SARS-CoV-2 spike protein [4]. NanoLink also contains a hinge region of an IgG FC domain (from the Etanercept sequence) which permits dimerization. Similarly, the NanoTrim fusion protein contains a hinge-isoleucine zipper domain which permits trimerization [5]. These control polypeptides also have an INF-β secretion sequence at the N-terminus to permit secretion from the expression cells.

The nanobody region of the NanoLink (SEQ ID NO: 16) and NanoTrim (SEQ ID NO: 18) constructs binds to the SARS-CoV-2 surface glycoprotein receptor biding domain (RBD) of the NanoSpike construct (or the NanoSpikeORF8 or NanoSpikeORF3b constructs, each of which contains the SARS-CoV-2 spike proteins RBD domain) and can cause hemagglutination (in the absence of a subject's anti-SARS-CoV-2 antibodies) and permits a side-by-side comparison of the assay results with assays conducted with NanoNuc (SEQ ID NO: 4), NanoORF8 (SEQ ID NO: 6), NanoSpikeORF8 (SEQ ID NO: 8), NanoORF3b (SEQ ID NO: 10), NanoSpikeORF3b and NanoControl (as a negative control). Collectively, these constructs permit a cross-validated assay that can be used to assess the presence of anti-SARS-CoV-2 antibodies in a subject's blood.

Polypeptide sequences of the NanoSpike, NanoNuc NanoORF8, NanoSpikeORF8, NanoORF3b, NanoSpikeORF3b, NanoControl, NanoLink, and NanoTrim constructs are shown in

TABLE 1 Nucleic acid sequences are provided in the sequence listing (odd SEQ ID NOs of the even number polypeptide SEQ ID NOs). Table 1. Polypeptide Constructs NanoSpike (SEQ ID NO: 1-2) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAARFPNITNLCPFGEVFNATRFASVYAWNRKRISNCVADYSVLYNSASFSTFKCYGVSPT KLNDLCFTNVYADSFVIRGDEVRQIAPGQTGKIADYNYKLPDDFTGCVIAWNSNNLDSKVGGNYNYLYRLFRKSNL KPFERDISTEIYQAGSTPCNGVEGFNCYFPLQSYGFQPTNGVGYQPYRVVVLSFELLHAPATVCGPKKSTNLEFGG GSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 377-390 RBC Binding Domain: 26-148 COVID Spike Domain: 171-376 Dual Strep Tag: 391-419 NanoNuc (SEQ ID NO: 3-4) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAAMSDNGPQNQRNAPRITFGGPSDSTGSNQNGERSGARSKQRRPQGLPNNTASWFTALTQ HGKEDLKFPRGQGVPINTNSSPDDQIGYYRRATRRIRGGDGKMKDLSPRWYFYYLGTGPEAGLPYGANKDGIIWVA TEGALNTPKDHIGTRNPANNAAIVLQLPQGTTLPKGFYAEGSRGGSQASSRSSSRSRNSSRNSTPGSSRGTSPARM AGNGGDAALALLLLDRLNQLESKMSGKGQQQQGQTVTKKSAAEASKKPRQKRTATKAYNVTQAFGRRGPEQTQGNF GDQELIRQGTDYKHWPQIAQFAPSASAFFGMSRIGMEVTPSGTWLTYTGAIKLDDKDPNFKDQVILLNKHIDAYKT FPPTEPKKDKKKKADETQALPQRQKKQQTVTLLPAADLDDFSKQLQQSMSSADSTQAEFGGGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 590-603 RBC Binding Domain: 26-148 COVID Nucleocapsid Domain: 171-589 Dual Strep Tag: 604-632 NanoORF8 (SEQ ID NO: 5-6) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAAQECSLQSCTQHQPYVVDDPCPIHFYSKWYIRVGARKSAPLIELCVDEAGSKSPIQYID IGNYTVSCLPFTINCQEPKLGSLVVRCSFYEDFLEYHDVRVVLDFIPRGGGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 274-288 RBC Binding Domain: 26-148 COVID ORF 8 Domain: 171-273 Dual Strep Tag: 289-317 NanoSpikeORF8 (SEQ ID NO: 7-8) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAARFPNITNLCPFGEVFNATRFASVYAWNRKRISNCVADYSVLYNSASFSTFKCYGVSPT KLNDLCFTNVYADSFVIRGDEVRQIAPGQTGKIADYNYKLPDDFTGCVIAWNSNNLDSKVGGNYNYLYRLFRKSNL KPFERDISTEIYQAGSTPCNGVEGFNCYFPLQSYGFQPTNGVGYQPYRVVVLSFELLHAPATVCGPKKSTNLEFSG GGGSGGGGSGGGGSAAA

IPRGGGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 377-397; 501-515 RBC Binding Domain: 26-148 COVID Spike Domain: 171-376 COVID ORF 8 Domain: 398-500 Dual Strep Tag: 516-544 NanoORF3b (SEQ ID NO: 9-10) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAAMAYCWRCTSCCFSERFQNHNPQKEMATSTLQGCSLCLQLAVVVNSLLTPFARCCWPEF GGGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 227-240 RBC Binding Domain: 26-148 COVID ORF 3b Domain: 171-226 Dual Strep Tag: 241-269 NanoSpikeORF3b (SEQ ID NO: 11-12) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTISGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GGTS GGGGSGGGGSGGGGSAAARFPNITNLCPFGEVFNATRFASVYAWNRKRISNCVADYSVLYNSASFSTFKCYGVSPT KLNDLCFTNVYADSFVIRGDEVRQIAPGQTGKIADYNYKLPDDFTGCVIAWNSNNLDSKVGGNYNYLYRLFRKSNL KPFERDISTEIYQAGSTPCNGVEGFNCYFPLQSYGFQPTNGVGYQPYRVVVLSFELLHAPATVCGPKKSTNLEFSG GGGSGGGGSGGGGSAAA

EFG GGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-170; 377-397; 454-467 RBC Binding Domain: 26-148 COVID Spike Domain: 171-376 COVID ORF 3b Domain: 398-453 Dual Strep Tag: 467-496 NanoControl (SEQ ID NO: 13-14) MTNKCLLQIALLLCFSTTALSM GAP QVQLQESGGGSVQAGGSLRLSCVASGYTDSTYCVGWFRQAPGKEREGVARI NTTSGRPWYADSVKGRFTISQDNSKNTVYLQMNSLKPEDTAIYYCTLTTANSRGFCSGGYNYKGQGTQVTVS GEFG GGSGGGSGGGS

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 149-163 RBC Binding Domain: 26-148 Dual Strep Tag: 164-192 NanoLink (SEQ ID NO:16) MTNKCLLQIALLLCFSTTALSM GAP QVQLVESGGGLMQAGGSLRLSCAVSGRTFSTAAMGWFRQAPGKEREFVAAI RWSGGSAYYADSVKGRFTISRDKAKNTVYLQMNSLKYEDTAVYYCARTENVRSLLSDYATWPYDYWGQGTQVTVS G GGGSGGGGSGGGGSID QVQLVESGGGLMQAGGSLRLSCAVSGRTFSTAAMGWFRQAPGKEREFVAAIRWSGGSAYY ADSVKGRFTISRDKAKNTVYLQMNSLKYEDTAVYYCARTENVRSLLSDYATWPYDYWGQGTQVTVS SGTGGGGSGG GGSGGGGSGSEPKSCDKTHTCPPCPAPELLGGPSVFLFPPKPKDTLMISRTPEVTCVVVDVSHEDPEVKFNWYVDG VEVHNAKTKPREEQYNSTYRVVSVLTVLHQDWLNGKEYKCKVSNKALPAPIEKTISKAKGQPREPQVYTLPPSREE MTKNQVSLTCLVKGFYPSDIAVEWESNGQPENNYKTTPPVLDSDGSFFLYSKLTVDKSRWQQGNVFSCSVMHEALH NHYTQKSLSLSPGKPRGGGSGGGSGGGSAA

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 152-168; 295-314; 547-562 SARS-CoV-2 Spike RBD specific nanobody (H11-D4): 26-151; 169-294 IgG-FC Dimerization domain: 315-546 Dual Strep Tag: 563-591 NanoTrim (SEQ ID NO: 17-18) MTNKCLLQIALLLCFSTTALSM GAP QVQLVESGGGLMQAGGSLRLSCAVSGRTFSTAAMGWFRQAPGKEREFVAAI RWSGGSAYYADSVKGRFTISRDKAKNTVYLQMNSLKYEDTAVYYCARTENVRSLLSDYATWPYDYWGQGTQVTVS G GGGSGGGGSGGGGSID QVQLVESGGGLMQAGGSLRLSCAVSGRTFSTAAMGWFRQAPGKEREFVAAIRWSGGSAYY ADSVKGRFTISRDKAKNTVYLQMNSLKYEDTAVYYCARTENVRSLLSDYATWPYDYWGQGTQVTVS SGT

PRGGGSGGGSGGGSAA

INF-β Secretion Sequence: Residues 1-22 Linkers: Residues 23-25; 152-168; 295-297; 360-375 SARS-CoV-2 Spike RBD specific nanobody (H11-D4): 26-151; 169-294 Hinge-isoleucine zipper domain (trimerization domain): 298-359 Dual Strep Tag: 376-404 Odd number SEQ ID NO are nucleotide sequences; event numbers are polypeptide sequences

The fusion proteins listed in Table 1 can be expressed in mammalian cells and particularly in human cell lines. In one embodiment the proteins are expressed in human embryonic kidney 293 cells (HEK 293). In another aspect, the proteins are expressed in Expi293F™ Cells (Thermo Fisher Scientific). The proteins are secreted into the media and are purified using affinity chromatography. In one aspect, the proteins are purified using Strep-Tactin®X (IBA) resin or beads on a column or batch format. The purified proteins were desalted and concentrated. Further polishing steps can be performed using ion exchange, gel filtration, or other chromatographic methods known in the art.

The diagnostic assays described herein require a minimal amount of whole blood (e.g., from a finger prick). Alternatively, subject plasma or serum can be used when combined with human red blood cells (e.g., from the subject or washed human red blood cells of blood group 0). A small amount of blood (e.g., 10-20 μL is typically combined with the test or control solutions (concentration of NanoSpike or other constructs: 20-60 μg/mL) at a ratio of ˜1:1 in an appropriate vessel (microfuge tub) or directly on a test card; gently mixed; and the reaction mixture is spread over the test card field (˜1 cm² diameter). The test card is rotated manually or with a mechanical rotor at 80-100 rpm for up to about 2-5 minutes and immediately read under direct light. The presence of hemagglutination (aggregation of red blood cells) is a positive result that indicates the presence of subject antibodies against SARS-CoV-2 antigens (e.g., surface glycoprotein, nucleocapsid, ORFS, OR3b, or a combination thereof).

The assay method described herein was validated using 40 COVID19-positive subjects (and 42 control subjects), with 98% sensitivity and 98% specificity. This assay enables simple, rapid, sensitive, specific, and inexpensive diagnosis and identification of subjects with SARS-CoV-2-specific antibodies, either as result of previous infection or successful vaccination. Information provided by this test is be valuable for epidemiological surveillance and decisions related to forthcoming vaccination efforts.

One embodiment described herein is a nucleotide sequence encoding a polypeptide, wherein the polypeptide comprises a human red blood cell binding antibody domain (RBD) and a SARS CoV-2 virus protein domain (CVD). In one aspect, the RBD comprises a glycophorin A-binding nanobody comprising 90-99% identity to SEQ ID NO: 22. In another aspect, the CVD comprises one or more of a spike protein, a nucleocapsid protein, ORF8 protein, ORF3b protein, or envelope protein comprising 90-99% identity to all or a portion of SEQ ID NO: 24, 26, 28, or 30.

In one aspect, the polypeptide has the structure:

-   -   SS-GAP-RBD-GL2-CVD-GL3-AFT or     -   SS-G L1-RBD-G L2-CVD-G L3-CVD-GL4-AFT;         wherein:         SS is a secretion signal domain;         RBD is a glycophorin A-binding nanobody domain;         GAP, GL1, GL2, GL3, and GL4 are linker domains;         CVD is a SARS CoV-2 virus polypeptide domain comprising a spike         protein, nucleocapsid protein,         ORF8 protein, ORF3b protein, or envelope protein domains; and         AFT is an affinity purification tag sequence.

In another aspect, the SS comprises 90-99% identity to SEQ ID NO: 20. In another aspect, the GAP, GL1, GL2, GL3, or GL4 comprises 90-99% identity to one or more of SEQ ID NO: 38, 40, 42, 44, or 46. In another aspect, the AFT comprises 90-99% identity to one or more of SEQ ID NO: 58, 60, 62, or 64. In another aspect, the nucleotide sequence has 90% to 99% identity to SEQ ID NO: 1, 3, 5, 7, 9, or 11. In another aspect, the nucleotide sequence is one of SEQ ID NO: 1, 3, 5, 7, 9, or 11.

Another embodiment described herein is a polynucleotide vector comprising a nucleotide sequence described herein.

Another embodiment described herein is a cell comprising a polynucleotide vector comprising a nucleotide sequence described herein.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein, wherein the polypeptide has 90% to 99% identity to SEQ ID NO: 2, 4, 6, 8, 10, or 12.

Another embodiment described herein is a polypeptide encoded by a nucleotide sequence described herein, wherein the polypeptide is SEQ ID NO: 2, 4, 6, 8, 10, or 12.

Another embodiment described herein is a diagnostic reagent or research tool comprising a polypeptide encoded by the nucleotide sequence described herein.

Another embodiment described herein is a method or means for manufacturing a nucleotide sequence as described herein or a polypeptide encoded by the nucleotide sequence, the process comprising: transforming or transfecting a cell with a nucleic acid comprising the nucleotide sequence; growing the cells; optionally, harvesting the cells and isolating quantities of the nucleotide sequence; inducing expression of a polypeptide encoded by the nucleotide sequence; harvesting the cells; and isolating and purifying the polypeptide.

Another embodiment described herein is a nucleotide sequence or a polypeptide encoded by the nucleotide sequence, each produced by a method or means described herein.

Another embodiment described herein is a nucleotide sequence encoding a diagnostic control polypeptide, wherein the polypeptide comprises: (a) a glycophorin A-binding nanobody domain comprising 90-99% identity to SEQ ID NO: 22; (b) one or more anti-SARS Co-V-2 nanobody domains comprising 90-99% identity to SEQ ID NO: 32 and one or more multimerization domains comprising 90-99% identity to SEQ ID NO: 34 o4 36.

In one aspect, the polypeptides have the structure:

-   -   SS-GAP-RBD-GL5-AFT;     -   SS-GAP-anti-CVD-GL6-anti-CVD-GL7-IgGFC-GL8-AFT; or     -   SS-GAP-anti-CVD-GL6-anti-CVD-SGT-HIZD-G L8-AFT;         wherein:

-   SS is a secretion signal domain;

-   RBD is a glycophorin A-binding nanobody domain;

-   GAP, GL5, GL6, GL7, GL8, and SGT are linker domains;

-   Anti-CVD is an anti-SARS CoV-2 surface glycoprotein receptor binding     domain nanobody domain;

-   IgGFC is a human immunoglobulin FC dimerization domain;

-   HIZD is a Hinge-isoleucine zipper trimerization domain; and

-   AFT is an affinity purification tag sequence.

In another aspect, the SS comprises 90-99% identity to SEQ ID NO: 20. In another aspect, the GAP, SGT, GL5, GL6, GL7, or GL8 comprises 90-99% identity to one or more of SEQ ID NO: 38, 48, 50, 52, 54, or 56. In another aspect, the AFT comprises 90-99% identity to one or more of SEQ ID NO: 58, 60, 62, or 64. In another aspect, the nucleotide sequence has 90% to 99% identity to SEQ ID NO: 13, 15, or 17. In another aspect, the nucleotide sequence is one of SEQ ID NO: 13, 15, or 17.

Another embodiment described herein is a polynucleotide vector comprising a nucleotide sequence encoding a diagnostic control polypeptide as described herein.

Another embodiment described herein is a cell comprising a polynucleotide vector comprising a nucleotide sequence encoding a diagnostic control polypeptide as described herein.

Another embodiment described herein is a diagnostic control polypeptide as described herein.

Another embodiment described herein is a diagnostic control polypeptide having 90% to 99% identity to SEQ ID NO: 14, 16, or 18.

Another embodiment described herein is a diagnostic control polypeptide having the polypeptide sequence of SEQ ID NO: 14, 16, or 18.

Another embodiment described herein is a diagnostic reagent or research tool comprising a polypeptide encoded by a nucleotide sequence described herein.

Another embodiment described herein is a diagnostic or control polypeptide comprising the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

Another embodiment described herein is a method for evaluating whether a subject is infected or has been infected with SARS-CoV-2, the method comprising: (a) providing a sample of a biological fluid from a subject in need of diagnosis; (b) combining the biological fluid with a diagnostic polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12 to form a subject sample; (c) optionally, combining a negative control reagent or a positive control polypeptide comprising 90 to 95% identity to the amino acid sequence of SEQ ID NO: 14 (negative control) or SEQ ID NO: 16 or 18 (positive controls), with the biological fluid and a diagnostic polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 10, or 12 to form one or more control samples; (d) permitting the subject sample and control samples to incubate for a period of time; (e) evaluating the results by visualization, imaging, optical density, impedance, or microscopy; and (f) optionally, comparing the subject sample and control samples to validate the subject sample results; wherein the presence of hemagglutination in the subject sample is a positive diagnostic indication of SARS-CoV-2 infection, and the absence of hemagglutination in the subject sample is a negative diagnostic indication of SARS-CoV-2 infection. In one aspect, the biological fluid is whole blood, plasma, or serum. In another aspect, when the biological fluid is plasma or serum, washed human red blood cells of blood group 0 are combined with the subject sample and the diagnostic or control polypeptides in steps (b) or (c). In another aspect, wherein the diagnostic or control polypeptides have a concentration of about 10 μg/mL to about 100 μg/mL. In another aspect, the subject sample and/or control samples in steps (b) and/or (c) are dispensed on a test card, glass slide, microtiter plate, or other substrate prior to step (d). In another aspect, when the subject sample has a positive diagnostic indication of SARS-CoV-2 infection, the method further comprises: (g) administering one or more therapeutics or treatments to the subject.

Another embodiment described herein is a kit comprising: (a) one or more diagnostic or control polypeptides comprising the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18; (b) a test substrate; and (c) optionally, a label or instructions for use. In one aspect, the kit further comprises one or more of alcohol saturated towelettes; finger prick lances, capillaries, or gloves.

Another embodiment described herein is the use of a polypeptide comprising 90 to 99% identity to the amino acid sequence of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 for the diagnosis of SARS-CoV-2 in a subject in need of diagnosis thereof.

Another embodiment described herein is a polynucleotide vector comprising one or more nucleotide sequences described herein. In one aspect, the nucleotide sequence comprises 85% to 100% identity to SEQ ID NO: 1, 3, 5, 7, 9, 11, 13, 15, or 17 and encodes a polypeptide having 85% to 100% identity to SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

Another embodiment described herein is a cell comprising one or more nucleotide sequences described herein or a polynucleotide vector described herein encoding one or more polypeptides. In one aspect, the nucleotide sequence has 85% to 100% identity to SEQ ID NO: 1, 3, 5, 7, 9, 11, 13, 15, or 17 and the encoded polypeptide has 85% to 100% identity to SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

Another embodiment is a diagnostic or control polypeptide encoded by a nucleotide sequence described herein. In one aspect, the nucleotide sequence has 85% to 100% identity to SEQ ID NO: 1, 3, 5, 7, 9, 11, 13, 15, or 17 and the encoded polypeptide has 85% to 100% identity to SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18. In another aspect, the diagnostic polypeptide is selected from SEQ ID NO: 2, 4, 6, 8, 10, or 12. In another aspect the control polypeptide is selected from SEQ ID NO: 14, 16, or 18

Another embodiment described herein is a process for manufacturing one or more of the nucleotide sequence described herein or a polypeptide encoded by the nucleotide sequence described herein, the process comprising: transforming or transfecting a cell with a nucleic acid comprising a nucleotide sequence described herein; growing the cells; optionally isolating additional quantities of a nucleotide sequence described herein; inducing expression of a polypeptide encoded by a nucleotide sequence of described herein; isolating the polypeptide encoded by a nucleotide described herein.

Another embodiment described herein is a means for manufacturing one or more of the nucleotide sequences described herein or a polypeptide encoded by a nucleotide sequence described herein, the process comprising: transforming or transfecting a cell with a nucleic acid comprising a nucleotide sequence described herein; growing the cells; optionally isolating additional quantities of a nucleotide sequence described herein; inducing expression of a polypeptide encoded by a nucleotide sequence of described herein; isolating the polypeptide encoded by a nucleotide described herein.

Another embodiment described herein is a nucleotide sequence or a polypeptide encoded by the nucleotide sequence produced by the method or the means described herein

Another embodiment described herein is the use of an effective amount of a polypeptide encoded by one or more of the nucleotide sequences described herein having 85% to 100% identity to SEQ ID NO: 1, 3, 5, 7, 9, 11, 13, 15, 17.

Another embodiment described herein is a research tool comprising a polypeptide encoded by a nucleotide sequence described herein.

Another embodiment described herein is an analytical reagent comprising a polypeptide encoded by a nucleotide sequence described herein.

The polynucleotides described herein include variants that have substitutions, deletions, and/or additions that can involve one or more nucleotides. The variants can be altered in coding regions, non-coding regions, or both. Alterations in the coding regions can produce conservative or non-conservative amino acid substitutions, deletions, or additions. Especially preferred among these are silent substitutions, additions, and deletions, which do not alter the properties and activities of the binding.

Further embodiments described herein include nucleic acid molecules comprising polynucleotides having nucleotide sequences about 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, or 99% identical, and more preferably at least about 90-99% or 100% identical to (a) nucleotide sequences, or degenerate, homologous, or codon-optimized variants thereof, encoding polypeptides having the amino acid sequences in SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 (b) nucleotide sequences, or degenerate, homologous, or codon-optimized variants thereof, encoding polypeptides having the amino acid sequences in SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18; and (c) nucleotide sequences capable of hybridizing to the complement of any of the nucleotide sequences in (a) or (b) above and capable of expressing functional polypeptides of amino acid sequences in SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

By a polynucleotide having a nucleotide sequence at least, for example, 90-99% “identical” to a reference nucleotide sequence encoding a polypeptide of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 is intended that the nucleotide sequence encoding the polynucleotide be identical to the reference sequence except that the polynucleotide sequence can include up to about 10 to 1 point mutations, additions, or deletions per each 100 nucleotides of the reference nucleotide sequence encoding a polypeptide of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

In other words, to obtain a polynucleotide having a nucleotide sequence about at least 90-99% identical to a reference nucleotide sequence, up to 10% of the nucleotides in the reference sequence can be deleted, added, or substituted, with another nucleotide, or a number of nucleotides up to 10% of the total nucleotides in the reference sequence can be inserted into the reference sequence. These mutations of the reference sequence can occur at the 5′- or 3′-terminal positions of the reference nucleotide sequence or anywhere between those terminal positions, interspersed either individually among nucleotides in the reference sequence or in one or more contiguous groups within the reference sequence. The same is applicable to polypeptide sequences about at least 90-99% identical to a reference polypeptide sequence.

As noted above, two or more polynucleotide sequences can be compared by determining their percent identity. Two or more amino acid sequences likewise can be compared by determining their percent identity. The percent identity of two sequences, whether nucleic acid or peptide sequences, is generally described as the number of exact matches between two aligned sequences divided by the length of the shorter sequence and multiplied by 100. An approximate alignment for nucleic acid sequences is provided by the local homology algorithm of Smith and Waterman, Advances in Applied Mathematics 2: 4 82-489 (1981). This algorithm can be extended to use with peptide sequences using the scoring matrix developed by Dayhoff, Atlas of Protein Sequences and Structure, M. O. Dayhoff ed., 5 suppl. 3: 353-358, National Biomedical Research Foundation, Washington, D.C., USA, and normalized by Gribskov, Nucl. Acids Res. 14(6): 6745-6763 (1986).

For example, due to the degeneracy of the genetic code, one having ordinary skill in the art will recognize that a large number of the nucleic acid molecules having a sequence at least 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% identical to the nucleic acid sequence shown in SEQ ID NO: 1, 3, 5, 7, 9, 11, 13, 15, or 17, or degenerate, homologous, or codon-optimized variants thereof, will encode a polypeptide having a sequence at least 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99%, or 100% identical to the polypeptide sequence shown in SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18.

The polynucleotides described herein include those encoding mutations, variations, substitutions, additions, deletions, and particular examples of the polypeptides described herein. For example, guidance concerning how to make phenotypically silent amino acid substitutions is provided in Bowie, J. U. et al., “Deciphering the Message in Protein Sequences: Tolerance to Amino Acid Substitutions,” Science 247: 1306-1310 (1990), wherein the authors indicate that proteins are surprisingly tolerant of amino acid substitutions.

Thus, fragments, derivatives, or analogs of the polypeptides of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 can be (i) ones in which one or more of the amino acid residues (e.g., 1, 2, 3, 4, 5, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 25, 30, 35, 40, 45, or 50 residues, or even more) are substituted with a conserved or non-conserved amino acid residue (preferably a conserved amino acid residue). Such substituted amino acid residues may or may not be one encoded by the genetic code, or (ii) ones in which one or more of the amino acid residues includes a substituent group (e.g., 1, 2, 3, 4, 5, 7, 8, 9, 10, 15, 20, 25, 30, 35, 40, 45, or 50 residues or even more), or (iii) ones in which the mature polypeptide is fused with another polypeptide or compound, such as a compound to increase the half-life of the polypeptide (for example, polyethylene glycol), or (iv) ones in which the additional amino acids are fused to the mature polypeptide, such as an IgG Fc fusion region peptide or leader or secretory sequence or a sequence which is employed for purification of the mature polypeptide or a proprotein sequence. Such fragments, derivatives, and analogs are deemed to be within the scope of those skilled in the art from the teachings herein.

In addition, fragments, derivatives, or analogs of the polypeptides of SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 can be substituted with one or more conserved or non-conserved amino acid residue (preferably a conserved amino acid residue). In some cases these polypeptides, fragments, derivatives, or analogs thereof will have a polypeptide sequence at least 50%, 55%, 60%, 65%, 70%, 75%, 80%, 85%, 90%, 91%, 92%, 93%, 94%, 95%, 96%, 97%, 98%, 99% or 100% identical to the polypeptide sequence shown in SEQ ID NO: 2, 4, 6, 8, 10, 12, 14, 16, or 18 and will comprise functional or non-functional proteins or enzymes. Similarly, additions or deletions to the polypeptides can be made either at the N- or C-termini or within non-conserved regions of the polypeptide (which are assumed to be non-critical because they have not been photogenically conserved).

As described herein, in many cases the amino acid substitutions, mutations, additions, or deletions are preferably of a minor nature, such as conservative amino acid substitutions that do not significantly affect the folding or activity of the protein or additions or deletions to the N- or C-termini. Of course, the number of amino acid substitutions, additions, or deletions a skilled artisan would make depends on many factors, including those described herein. Generally, the number of substitutions, additions, or deletions for any given polypeptide will not be more than about 100, 90, 80, 70, 60, 50, 40, 30, 25, 20, 19, 18, 17, 16, 15, 14, 13, 12, 11, 10, 9, 8, 7, 5, 6, 4, 3, 2, or 1.

It will be apparent to one of ordinary skill in the relevant art that suitable modifications and adaptations to the compositions, formulations, methods, processes, apparata, assemblies, and applications described herein can be made without departing from the scope of any embodiments or aspects thereof. The compositions, apparata, assemblies, and methods provided are exemplary and are not intended to limit the scope of any of the disclosed embodiments. All the various embodiments, aspects, and options disclosed herein can be combined in any variations or iterations. The scope of the compositions, formulations, methods, apparata, assemblies, and processes described herein include all actual or potential combinations of embodiments, aspects, options, examples, and preferences described herein. The compositions, formulations, apparata, assemblies, or methods described herein may omit any component or step, substitute any component or step disclosed herein, or include any component or step disclosed elsewhere herein. The ratios of the mass of any component of any of the compositions or formulations disclosed herein to the mass of any other component in the formulation or to the total mass of the other components in the formulation are hereby disclosed as if they were expressly disclosed. Should the meaning of any terms in any of the patents or publications incorporated by reference conflict with the meaning of the terms used in this disclosure, the meanings of the terms or phrases in this disclosure are controlling. All patents and publications cited herein are incorporated by reference herein for the specific teachings thereof.

REFERENCES

-   1. Kontou et al., “Antibody Tests in Detecting SARS-CoV-2 Infection:     A Meta-Analysis,” Diagnostics (Basel) 10(5):319 (2020). -   2. Gudbjartsson et al., “Humoral Immune Response to SARS-CoV-2 in     Iceland,” N. Engl. J. Med. 383(18):1724-1734 (2020). -   3. Hachim et al., “ORF8 and ORF3b antibodies are accurate     serological markers of early and late SARS-CoV-2 infection,” Nat.     Immunol. 21(10):1293-1301 (2020). -   4. Huo et al., “Neutralizing nanobodies bind SARS-CoV-2 spike RBD     and block interaction with ACE2,” Nat. Struct. Mol. Biol. 27(9):     846-854 (2020). -   5. Tillib et al., “Formatted single-domain antibodies can protect     mice against infection with influenza virus (H5N2),” Antiviral Res.     97(3):245-254 (2013). -   6. Redecke et al., “Hematopoietic progenitor cell lines with myeloid     and lymphoid potential,” Nat. Methods 10(8): 795-803 (2013). -   7. Lee et al., “Production of specific antibodies against     SARS-coronavirus nucleocapsid protein without cross reactivity with     human coronaviruses 229E and OC43,” J. Vet. Sci. 11(2): 165-167     (2010). -   8. Lee et al., “Detection of antibodies against SARS-Coronavirus     using recombinant truncated nucleocapsid proteins by ELISA,” J.     Microbiol. Biotechnol. 18(10): 1717-1721 (2008). -   9. Dutta et al., “Search for potential target site of nucleocapsid     gene for the design of an epitope-based SARS DNA vaccine,” Immunol.     Let. 118(1): 65-71 (2008). -   10. Gupta and Chaudhary, “Whole-blood agglutination assay for     on-site detection of human immunodeficiency virus infection,” J.     Clin. Microbiol. 41(7): 2814-2821 (2003). -   11. Kemp et al., “Autologous red cell agglutination assay for HIV-1     antibodies: simplified test with whole blood,” Science     241(4871):1352-1354 (1988). -   12. Gupta and Chaudhary, “Expression, purification, and     characterization of an anti-RBCFab-p24 fusion protein for     hemagglutination-based rapid detection of antibodies to HIV in whole     blood,” Protein Expr. Purif. 26(1): 162-170 (2002). -   13. Habib et al., “V(H)H (nanobody) directed against human     glycophorin A: a tool for autologous red cell agglutination assays,”     Anal. Biochem. 438(1): 82-89 (2013). -   14. Tai et al., “Characterization of the receptor-binding domain     (RBD) of 2019 novel coronavirus: implication for development of RBD     protein as a viral attachment inhibitor and vaccine,” Cell. Mol.     Immunol. 17(6): 613-620 (2020). -   15. Ravichandran et al., “Antibody signature induced by SARS-CoV-2     spike protein immunogens in rabbits,” Sci. Transl. Med. 12(550):     eabc3539 (2020). -   16. Grzelak et al., “A comparison of four serological assays for     detecting anti-SARS-CoV-2 antibodies in human serum samples from     different populations,” Sci. Transl. Med. 12(559): eabc3103 (2020).

EXAMPLES Example 1

Plasmids

DNA encoding expressed proteins was synthesized by commercial suppliers (Thermo Fisher Scientific/Invitrogen, Synbio, Biomatic) and cloned by standard molecular biology methods into the mammalian expression vector pcDNA3.1(+) (Invitrogen). All coding sequences were confirmed by Sanger sequencing.

Protein Expression

All proteins were expressed in Expi293F™ cells (Thermo Fisher Scientific) using the ExpiFectamine™ 293 Transfection Kit following the manufacturer's instructions (Thermo Fisher Scientific). In brief, cells were cultured at 37° C. and 8% CO₂ in 25 mL of Expi293 expression medium (Thermo Fisher Scientific) in 125 mL bottles on a 25 mm orbital shaker (120 rpm) until reaching a density of 4.5-5.5×10⁶/mL. Cells were seeded at 3×10⁶/mL in 25 mL per 125 mL flasks for transfection. 25 μg of DNA and 80 μL of Epifectamine was added to 1.5 mL and 1.4 mL Opti-Plex complexation buffer (Thermo Fisher Scientific), respectively. After a 3-5 min incubation at room temperature (RT), the two solutions were combined, gently mixed, incubated for 15 min at RT and added dropwise to cells. After overnight culture, Epifectamine transfection enhancer 1 (150 μL) and Epifectamine transfection enhancer 2 (1.5 mL) was added, and cell suspensions were harvested two days later.

Protein Purification

Cell suspensions were centrifuged at 450 g for 5 min and protein-containing supernatant was cleared using 0.2 μm filter bottles. To remove biotin (interfering with affinity purification), 3 mL of 10× buffer W (1M Tris-HCl pH 8.0, 1.5 M NaCl, 10 mM EDTA) was added to the supernatant along with 600 μL of BioLock solution (IBA), followed by ultracentrifugation at 20,000×g for 20 min at 4° C. The resulting supernatant was loaded on columns containing 700 μL of washed Strep-Tactin® XT matrix (IBA). The columns were rinsed five times with 1 mL ice-cold PBS, proteins were eluted with 3×500 μL of buffer BXT (IBA), concentrated on Amicon Ultra3k concentration columns (3 kD cutoff) at 14,000×g at 4° C. and desalted by centrifugation at 1500× g for 2 min using TBS-equilibrated Zeba Spin desalting columns (0.5 mL, 7 k MWCO, Thermo Fisher Scientific). 3-10 μg of each purified proteins was analyzed by SDS PAGE and Sypro Ruby staining (Thermo Fisher Scientific).

Example 2

Design, Expression and Purification of Recombinant Proteins

Due to the known robustness of nanobodies and the availability of required sequence information. Methodologically, a modified form of the IH4 nanobody (IH4vs2) was fused to the receptor-binding domain of the Spike protein of SARS-CoV-2, which has been shown in various analyses to represent a highly immunogenic region [6-8]. Mammalian cells were used for protein expression. The SARS Co-V-2 surface “spike” glycoprotein is physiologically targeted to the secretory pathway, which is likely required for proper protein folding and accompanied by glycosylation, which in turn may be relevant for the antibody response and thus test specificity [9]. To allow for proper targeting to the secretory pathway, a secretion signal derived from interferon-β was fused to the N-terminus of the fusion protein (FIG. 1). A tandem Strep-tag was fused to the C-terminus to allow for efficient one-step protein purification. Flexible glycine-serine-containing linkers were placed between the functional units of the fusion protein to avoid interference of the different domains. A similar protein lacking the Spike RBD was cloned as negative control (FIG. 1). The proteins were expressed first in small scale, then in larger scale experiments in either ExpiCho-S™ or Expi293F™ cells (Thermo Fisher Scientific), both of which are optimized for high density growth in suspension and used extensively in the pharmaceutical industry. As shown for experiments based on Expi293F™ cells, protein expression and Strep-tag-based one-step purification was very efficient, resulting in virtually homogenous protein preparations for both the NanoSpike and the NanoControl protein (FIG. 3-5). Around 2 mg of protein were obtained from 30 mL of cell culture, reflecting a highly efficient process.

Example 3

Functional Activity of Recombinant Proteins in Hemagglutination Assays

To determine whether the NanoSpike protein binds to red blood cells, different concentrations of the NanoSpike protein were incubated with human whole blood, followed by visualization using FITC-conjugated anti-Strep-tag antibodies and flow cytometry (FIG. 6-7). As expected, NanoSpike bound efficiently and in a concentration-dependent manner to RBC.

In order to determine if NanoSpike cross-linking induces visible hemagglutination of RBC, the NanoSpike protein was added to a small drop (10 μL) of human whole blood, either in the absence of antibodies, anti-Strep antibodies (crosslinking) or anti-CD4 antibodies (negative control). Indeed, in the presence of NanoSpike, anti-Strep antibodies induced instant hemagglutination in a concentration-dependent way. anti-Strep antibodies alone or anti-Strep antibodies in the presence of αCD4 antibodies showed no effect, demonstrating specificity. Given that the anti-Strep antibodies is a monoclonal IgG1 antibodies, these data also suggest that the valency of IgG is sufficient to trigger agglutination (as opposed to the higher valency of IgM).

To obtain proof of principle for NanoSpike activity in the presence of physiological αSpike antibodies, whole blood of a confirmed COVID19 patient was combined with NanoSpike or NanoControl protein. Indeed, similar to the anti-Strep antibody-treated samples, NanoSpike mediated instant hemagglutination. NanoSpike expressed from ExpiCho-S and Expi293F cells showed the same activity. As the protein amount obtained from Expi293F cells was slightly higher, these cells were used for further expression. Of note, NanoControl protein did not exhibit any agglutination, even during extended periods of time, suggesting that agglutination is solely governed by the Spike RBD moiety, respectively antibodies directed against Spike. This experiment was confirmed with two patients two weeks after being tested PCR-positive (not shown).

Example 4

To further substantiate the initial testing described above, five plasma samples from COVID19 patients with ELISA-positive αSARS-CoV-2 antibody titers was tested, along with five confirmed antibody-negative control samples. Plasma was used for these assays because it was immediately available from frozen stocks maintained at a reference laboratory (ARUP). For these assays, washed RBC from a healthy donor were used and combined NanoSpike (or NanoControl) protein along with plasma from test samples. All COVID19-positive samples showed immediate hemagglutination in the presence of NanoSpike, but not the NanoControl protein, while all COVID19-negative samples remained without detectable hemagglutination. Even though blood plasma is not the intended major type of material typically used for the assay (i.e., the preferred sample is finger stick capillary blood), it has the advantage that it can be titrated independent of RBC and was useful to assess the sensitivity of the assay at different antibodies concentrations. This facilitated the testing and optimization of other viral proteins fused to the Nanobody (e.g., NanoNuc, NanoORF8, NanoORF3b, NanoSpikeORF8, NanoSpikeORF3b).

Example 5

The assay was further validated using serum from patients which had been tested with an FDA-approved Spike-ELISA (Euroimmun). Forty ELISA-positive and forty-two ELISA-negative cases were enrolled. NanoControl, NanoSpike and NanoLink recombinant proteins (30 μg/mL) were added to washed RBC along with the subject serum and the presence or absence of hemagglutination was observed and documented (FIG. 8.). The number of cases that were correctly identified by the NanoSpike test (in a blinded analysis) are shown in Table 2.

Based on these assays, specificity, and sensitivity were calculated according to standard formulas: Sensitivity=number of true test-positive divided by (number of true test-positive plus number of false negatives). Specificity=number of true test-negatives divided by (number of true test-negatives plus number of false positives).

TABLE 2 NanoSpike identifies sero-positive COVID19 patients with high specificity and sensitivity. Euroimmune ELISA (Spike) (82 patients) ELISA (Number of cases) 40 42 (test-positive) (test-negative) NanoSpike Agglutination (number of 39 41 correct identifications) NanoSpike Agglutination (number of 1 1 incorrect identifications) Specificity (%) 98 Sensitivity (%) 98

Example 6

NanoSpike Assay Methodology

Assay Reagents/Components:

Subject sample: blood, serum, plasma, or other bilogical fluid sample (described below)

NanoSpike, NanoNuc, NanoORF8, NanoORF3b, NanoSpikeORF8, NanoSpikeORF3b, or other Nanobody (IH4vs2)-conjugated proteins (20-60 μg/mL): glycophorin targeting nanobody conjugated to SARS-CoV-2 proteins

NanoControl (20-60 μg/mL): Negative control, glycophorin targeting nanobody alone

NanoLink (20-60 μg/mL): Positive control, test substance (20-60 μg/mL); SARS-CoV-2 Spike-targeting nanobody construct (based on the H11-D4 nanobody) fused to the Hinge-FC part of IgG1 protein. This compound mimics dimerizing anti-Spike antibodies.

NanoTrim (20-60 μg/mL):Positive control, test substance (20-60 μg/mL), SARS-CoV-2 Spike-targeting nanobody construct (based on the H11-D4 nanobody) fused to trimerizing Hinge-isoleucine zipper domain. This compound mimics multimerizing anti-Spike antibodies. Miscellaneous Items: Test cards; gloves; alcohol (70% isopropanol) towelettes; finger prick lances; bandages; pipets, pipet tips, microfuge tubes, magnifying means, bright light; biohazard disposal receptacle; etc. Specimen Collection Total Blood

Blood was collected in vacutainers or collection tubes containing EDTA by venipuncture or finger-stick.

Plasma

Blood was collected in vacutainers containing EDTA by venipuncture and plasma was separated by centrifugation.

Serum

Blood was collected in vacutainers containing no anticoagulants by venipuncture and plasma was separated by centrifugation after the blood had clotted.

Test Procedures (at Room Temperature, ˜25° C.):

Total Blood

A small amount of blood, e.g., 10-20 μL, was combined with test or control solutions at a ratio of ˜1:1, gently mixed, and the reaction mixture was spread over the test card field (˜1 cm² diameter).

The test card was rotated manually or with a mechanical rotor at 80-100 rpm for 2-5 minutes and immediately read under direct light.

The presence of hemagglutination was a positive result. The absence of hemagglutination was a negative result. Results were compared to positive and/or negative control samples using the same subject sample.

Plasma and Serum

A small amount of plasma or serum, e.g. 5-10 μL, was combined with a small amount, e.g., 5-10 μL, of washed human red blood cells (RBC) of blood group 0. RBCs can be used pure or diluted with PBS up to 1:10.

The test or control solutions are added to the plasma/serum/RBC mixture at a ratio of 1:1, gently mixed and the reaction mixture was spread over the test field (˜1 cm² diameter).

The test card was rotated manually or with a mechanical rotor at 80-100 rpm for 2-5 minutes and immediately read under direct light.

The presence of hemagglutination was a positive result. The absence of hemagglutination was a negative result. Results were compared to positive and/or negative control samples using the same subject sample.

Hemagglutination can be visually read on cardboard test cards or on glass slides. Alternative assay systems include the use of microtiter plates, gel immunodiffusion, ouchterlony, or automated systems that can detect agglutination, e.g., by still or video imaging, optical density, impedance, microscopy, or using specific applications developed for this purpose.

Exemplary Cost Analysis

One advantage of the assays described herein is their simplicity and low costs. Based on regular prices (not wholesale), estimated material costs for protein expression and purification amount to ˜$0.019/assay, and additional equipment (also regular retail prices), including lancets, capillaries, and ethanol wipes amount to ˜$0.30/assay. While overhead costs for personnel and logistics need to be accounted, it is expected that up-scaled protein production and wholesale prizes for equipment will further reduce production costs. 

What is claimed:
 1. A polypeptide comprising a human red blood cell binding antibody domain (RBD) comprising a glycophorin A-binding nanobody comprising 90-99% identity to the polypeptide sequence of SEQ ID NO: 22 and a SARS CoV-2 virus protein domain (CVD).
 2. The polypeptide of claim 1, wherein the RBD comprises a glycophorin A-binding nanobody having a polypeptide sequence of SEQ ID NO:
 22. 3. The polypeptide of claim 1, wherein the CVD comprises one or more of a spike protein comprising 90-99% identity to all or a portion of the polypeptide sequence of SEQ ID NO:
 24. 4. The polypeptide of claim 3, wherein the polypeptide has the structure: SS-GAP-RBD-GL2-CVD-GL3-AFT wherein: SS is a secretion signal domain; RBD is a glycophorin A-binding nanobody domain; GAP is a linker domain; CVD is a SARS CoV-2 virus polypeptide domain comprising a spike protein domain; and AFT is an affinity purification tag sequence.
 5. The polypeptide of claim 4, wherein the SS comprises 90-99% identity to SEQ ID NO:
 20. 6. The polypeptide of claim 4, wherein the GAP domain comprises 90-99% identity to SEQ ID NO:
 38. 7. The polypeptide of claim 4, wherein the affinity purification tag (AFT) comprises 90-99% identity to SEQ ID NO:
 60. 8. The polypeptide of claim 1, wherein the polypeptide is encoded by a nucleotide sequence having 90% to 99% identity to SEQ ID NO:
 1. 9. The polypeptide of claim 1, wherein the polypeptide is encoded by a nucleotide sequence of SEQ ID NO:
 1. 10. A polynucleotide vector comprising a nucleotide sequence of claim
 9. 11. A cell comprising a polynucleotide vector of claim
 10. 12. The polypeptide of claim 1, wherein the polypeptide has 90% to 99% identity to SEQ ID NO:
 2. 13. A method for evaluating whether a subject is infected or has been infected with SARS-CoV-2, the method comprising: (a) providing a sample of a biological fluid from a subject in need of diagnosis; (b) combining the biological fluid with a polypeptide of claim 12; (c) permitting the subject sample and control samples to incubate for a period of time; (d) evaluating the results by visualization, imaging, optical density, impedance, or microscopy; and wherein the presence of hemagglutination in the subject sample is a positive diagnostic indication of SARS-CoV-2 infection, and the absence of hemagglutination in the subject sample is a negative diagnostic indication of SARS-CoV-2 infection.
 14. The method of claim 13, wherein the biological fluid is whole blood, plasma, or serum.
 15. The method of claim 14, wherein when the biological fluid is plasma or serum, washed human red blood cells of blood group O are combined with the subject sample and the diagnostic or control polypeptides in steps (b) or (c).
 16. The method of claim 13, wherein the diagnostic or control polypeptides have a concentration of about 10 μg/mL to about 100 μg/mL.
 17. The method of claim 13, wherein the subject sample in step (b) is dispensed on a test card, glass slide, microtiter plate, or other substrate prior to step (c).
 18. The method of claim 13, wherein when the subject sample has a positive diagnostic indication of SARS-CoV-2 infection, the method further comprises: (g) administering one or more therapeutics or treatments to the subject.
 19. A kit comprising: (a) a diagnostic polypeptide comprising the amino acid sequence of SEQ ID NO: 2; (b) a test substrate; and (c) optionally, a label or instructions for use.
 20. The kit of claim 19, further comprising one or more of alcohol saturated towelettes; finger prick lances, capillaries, or gloves. 